Treat all claims about harm from alcohol sanitisers with extreme caution. The evidence from extensive use in healthcare and from numerous studies is that a properly formulated alcohol sanitiser causes no harm to the skin and can actually act as a mild emollient. If you need more I have a lot of information on this and will be happy to respond off the forum. If you would like more PM me with your contact details.

Thank you. The request came from a school who were asking if any formal guidance has been published. I agree with your comments and will go back to them. I will contact you if they still worry.

No shortage of sinks in any school I have ever visited!

I now have someone who works for us whose daughter has developed a bad irritant contact dermatitis from the frequent and intensive hand washing that the school is insisting upon. She is now particularly vulnerable to infection as the barrier in her skin is almost non-existent and COVID-19 (and other tranisent micro-organisms) will find it easy to colonise her skin infecting her and potentially others. I have provided the mother with a personal pack of alcohol sanitiser and skin conditioning lotion and told her to tell the school that she must not use the soap unless her hands are visibly soiled. This is only one of several reports I now have that the 'frequent hand washing' advice is resulting in damaged skin, not necessarily at school but in a variety of workplaces, including offices. Why is the official advice ignoring the consequences of frequent hand washing without the additional step of applying a moisturising lotion to restore the lost surface film in the skin that is essential if it is to function as a proper barrier?

If you knew what frequent handwashing can do to the skin you would not have made that statement. It is a major cause of contact dermatitis among nurses. Each time you wash your hands you remove most of the hydrolipidic film - which is only a few microns thick - from the skin. The result is that frequent hand washing is the most common cause of occupational contact dermatitis. The statement that they were considering a claim is simply not the case. The mother was simply concerned - as I was - to protect her child from what was being done to her.

Children are being made to wash more frequently that was usual. They are also being made to have their soap on their hands for longer than was normal. The result is now appearing in frequent claims that hands are being damaged. Furthermore, the advice takes no account of those (estimated at around 25% of the population as a whole) who are atopic, i.e. have a genetic modification that makes them particular sensitive to irritants such as soap and water. 

One example from the many documents on my computer:

“A prospective multicentre study evaluating skin tolerance to standard hand hygiene techniques”

This study evaluated the effect on the skin (dryness, irritation) comparing hand washing with alcohol sanitising rubs. From the conclusions . . .

“The results from the 1932 assessments collected show that standard handwashing is a risk factor for dryness and irritation, whereas the alcohol based hand rub causes no skin deterioration and might have a protective effect, particularly in intensive use.”

Chamorey et al, American Journal of Infection Control, 2011, 39, 6-13

Is this not a situation where each case should be dealt with on it's merits?

Clearly if the handwashing is causing sensitization in an individual then that individual should stop washing and use another method. If they have open wounds on their hands which cannot be dressed adequately, maybe they should not be in school at all. Most people will be ok to continue washing at a reasonable rate, ie first thing in the morning upon entering school is all we have changed, after toilet and before lunch has always been a requirement. Any more than that is not based on anything more than hyperbole. How often? Every hour? every 20 mins, every 15? who knows what or who a child has touched in that time. The benefit is not measured on a linear scale.

It's all bows and arrows against the Gods, they are only in school for a short period, are they confined to barracks when they get home?

I know if  I washed my hands stupid often I'd be a bleeding wreck by the end of day two! Perspective and sense are needed here. Yes, it's serious, yes it's awful, but evidence based controls are what we need. When the balance of benefit levels out there is no need to keep piling on the measures.

Agreed Chris.

Unfortunately in the real world that process is just not enforcable, limited staff, limited time, schedules to stick to, make it nigh on impossible to police it properly. We are talking kids here.

And I can just imagine the scene if we said the parents are most welcome to come down to school every 20 mins with a bottle of alcohol gel but they can't leave it at school! Fixing one problem causes another (as usual)

I don't know the answers. What you propose is correct, but I humbly suggest not workable.

Like many others, I'm allergic to most soaps - they contain the dreaded Limonene - & my hands are really suffering. I now carry a small travel bottle of my own liquid soap - easy to pop in my pocket. Personally I won't be using 60% alcohol sanitiser - I restrict that to when I have to visit hospitals, frail elderly relatives.

Alcohol, particularly the industrial type used in hand sanitsers can be absorbed.

It is not of sufficient quantity to impact the ability of someone to drive or operate plant (unless they drink it).

As for issues of faith most consider it halal as the intended use is not for oral consumption and it is of manufactured rather than natural origin.

I have a copy of a study showing that alcohol sanitising rub is not absorbed through the skin. If you would like a copy of this PM me with an e-mail address and I will happily send it to you.

The following are extracts from the material I have for my talks on hand hygiene and infection prevention:

This study evaluated the effect on the skin (dryness, irritation) comparing hand washing with alcohol sanitising rubs. From the conclusions . . .

“The results from the 1932 assessments collected show that standard handwashing is a risk factor for dryness and irritation, whereas the alcohol based hand rub causes no skin deterioration and might have a protective effect, particularly in intensive use.”

A prospective multicentre study evaluating skin tolerance to standard hand hygiene techniques”- Chamorey et al, American Journal of Infection Control, 2011, 39, 6-13

“Despite some methodological flaws and data gaps, evidence for a causal relationship between hand hygiene and reduced transmission of infections is convincing, but frequent hand washing causes skin damage, with resultant changes in microbial flora, increase skin shedding, and risk of transmission of microorganisms, suggesting that some traditional hand hygiene practices warrant re-examination. Some recommended changes in practice include use of waterless alcohol-based products and incorporation of moisturizers into skin care regimens of health care professionals.”

Larssen E, Skin Hygiene and Infection Prevention: More of the Same of Different Approaches?, Clinical Infectious Diseases, 1999, 29, 1287-94

Why is there no mention of moisturising in the official guidance on hand washing?